- The classic clinical presentation of Neurogenic Shock is shock (hypotension) with warm extremities and bradycardia after a trauma causing a Spinal Cord Injury above the level of T6.
- Bradycardia is more common in higher cervical injuries.
- Neurogenic Shock is different than Spinal Shock which manifests as transient flaccid paralysis and loss of sensation distal to the level of injury and lasting days to weeks before spontaneous resolution of symptoms.
- Prepare to secure the airway if the patient presents with signs of respiratory compromise. This can be secondary to polytrauma, airway edema or hematoma expansion as well as high cervical spine injuries resulting in diaphragmatic paralysis.
- Prompt surgical intervention as soon as the injury is identified.
- Avoid aggressive IV fluid.
- Initiate a vasopressor early. Norepinephrine is a first-line agent here. Current evidence recommends maintaining of MAP of 85-90 mmHg.
- Carefully watch and correct for hypothermia, which can develop secondary to systemic vasodilation.
- Neurogenic Shock is a diagnosis of exclusion. Consider it in your trauma patient with unexplained hypotension and bradycardia after ruling out hemorrhage or other internal injuries (Tension Pneumothorax, Pericardial Tamponade, etc.)
- In elderly patients, factors such as medications (Beta Blockers) or age-related neurocognitive deficits can mask the severity of their symptoms. Maintain a low threshold for considering spinal injuries in these patients.
- Mapelli E, Sabhaney V. “Neurogenic Shock.”Tintinalli’s Emergency Medicine: A Comprehensive Study Guide, 8eEds. Judith E. Tintinalli, et al. New York, NY: McGraw-Hill, 2016, pg 1720-1721.
- Stein DM, Knight WA 4th. Emergency Neurological Life Support: Traumatic Spine Injury. Neurocrit Care. 2017;27(Suppl 1):170-180. doi:10.1007/s12028-017-0462-z
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